CHEST 2023 On Demand Pass-Pathology: A Diagnostic Key

Video Transcription

Video Summary

The patient in this case is a 46-year-old woman who presented to the hospital with difficulty breathing, cough, and weakness. She had a past medical history of lung nodules and a biopsy confirmed a diagnosis of neuroendocrine tumor. However, further investigation revealed that her previous diagnosis was actually incorrect and she was diagnosed with nephroblastoma or Wilms tumor instead. Wilms tumor is a pediatric malignancy that is rarely reported in adults, especially with a late relapse occurring more than 40 years after the initial diagnosis. The patient had a unique immunohistochemical profile with TTF1 positivity, WT1 negativity, and a metastatic tumor that resembled a typical nephroblastoma. This presence of TTF1 positivity, negative WT1 expression, and late pulmonary metastasis of nephroblastoma in adults is unusual and can potentially result in misdiagnosis. The correct diagnosis was made after a thorough histopathological workup, including additional immunostaining. The case highlights the importance of a thorough patient history and coordination between clinical departments to ensure an accurate diagnosis. In conclusion, this case contributes to our understanding of late recurrent metastatic Wilms tumor and emphasizes the need for further study of unique features such as loss of WT1 expression, weight presenting nephroblastoma in adults, or lung metastasis.

Meta Tag

Category Lung Pathology

Session ID 4017

Speaker Bhanusowmya Buragamadagu

Speaker Ibrahim Haddad

Speaker Diana Song

Speaker Javier Torres

Speaker Victoria Walker

Speaker Ibrahim Zahid

Track Lung Pathology

Keywords

patient

difficulty breathing

neuroendocrine tumor

nephroblastoma

late relapse

metastatic tumor

misdiagnosis

pulmonary metastasis